<div id="reg-box-step-2" class="grid_9 m-t-40 b-g-c-w p-r z-i-1 b-d-c-ddd reprefix-6 b-s-d-big pie">
    <h4 class="b-g-c-blue h-g-1 l-h-40 p-l-20 p-r-20">Thông tin bổ xung</h4>
    <div class="p-20 p-r">
        <div class="p-a t-0 l-0 b-0 r-0 tranf-w-50 d-p-n" style="z-index: 1001"></div>
        <div class="p-a t-0 l-0 b-0 r-0 b-g-ldg b-g-c-w _overflow" style="z-index: 1002"></div>
        <form id="frm-step-2" name="frm-step-2" action="{{"widgets/ei"|base_url}}" method="POST" 
            onsubmit="return false;" 
            target="integration_asynchronous" autocomplete="off" 
            >
            <div class="p-r p-b-12 f-l">
                <div class="grid_4">
                    <!--      birth      -->
                    <div class="p-r-2">
                        <div class="p-r">
                            <p><label class="d-p-b w-i" for="_phone">Di động</label></p>
                            <input 
                                type="text" 
                                class="w-i b-g-c-i validate[custom[phone]]" 
                                value="" 
                                minlength="7"
                                maxlength="20" 
                                id="_phone" name="_phone"
                                />
                        </div>
                    </div>
                </div>
                <div class="grid_4">
                    <!--      year      -->
                    <div class="p-l-2">
                        <div class="p-r">
                            <p><label class="d-p-b w-i" for="_tel">Điện thoại bàn</label></p>
                            <input 
                                type="text" 
                                class="w-i b-g-c-i validate[custom[phone]]" 
                                value="" 
                                minlength="7"
                                maxlength="20" 
                                id="_tel" name="_tel"
                                />
                        </div>
                    </div>
                </div>
            </div>
            <div class="clear"></div>
            <!--      address      -->
            <div class="p-r p-b-12">
                <p><label class="d-p-b w-i" for="_address">Địa chỉ</label></p>
                <input 
                    type="text" 
                    class="w-i b-g-c-i" 
                    value="" 
                    minlength="10"
                    maxlength="120" 
                    id="_address" name="_address"
                    />
            </div>
            <div class="clear"></div>
            <!--      like      -->
            <div class="p-r p-b-12">
                <p>Sở thích của bạn</p>
                <div class="p-r w-320">
                    <select id="_mul_st" class="w-i p-a t-0 l-0" name="_mul_st" multiple="true" size="1">
                        <option value="option1">Chơi game</option>
                        <option value="option2" selected="1">Nghe nhạc trực tuyến</option>
                        <option value="option3">Tham gia mạng xã hội</option>
                        <option value="option4">Mua sắm trực tuyến</option>
                        <option value="option5">Tìm kiếm bạn bè</option>
                        <option value="option6">Du lịch</option>
                        <option value="option7" selected="1">Ngủ thật nhiều cho đã.</option>
                    </select>
                </div>
                <p class="erc"></p>
            </div>
            <div class="p-r">
                <div id="step-2-back" class="b-t-c g-d-w f-l m-r-8">Back</div>
                <div id="step-2-next" class="b-t-c g-d-w f-r">Next</div>
            </div>
        </form>
            <div class="clear"></div>
    </div>
</div>